EVIDENCE ACQUISITION: In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review.

EVIDENCE SYNTHESIS: Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators.

DESIGN: Using a descriptive qualitative research approach informed by Levesque's framework of access to healthcare, we conducted phone interviews in the Malaysian language, which were audio-recorded and transcribed verbatim. Data were analysed inductively using a reflexive thematic analysis approach.

SETTING: Primary care clinics in five states in Peninsular Malaysia.

PARTICIPANTS: Adult patients with obesity receiving face-to-face care for obesity from healthcare providers in Peninsular Malaysia.

RESULTS: We interviewed 22 participants aged 24-62, with the majority being female (77%), Malay (95%), married (73%) and with tertiary education (82%). Most participants attended obesity management services at public primary care clinics. We identified five themes: (1) moving from perceiving the need to seeking obesity care is a non-linear process for patients, (2) providers' words can inspire patients to change, (3) patients' needs and preferences are not adequately addressed in current obesity care, (4) over-focusing on weight by patients and healthcare providers can lead to self-blame and loss of hope for patients and (5) obesity healthcare can have consequences beyond weight loss.

METHODS: MyBFF@school is a school-based, cluster randomized controlled trial (C-RCT) study. The investigators selected government schools from Federal Territory of Kuala Lumpur, Selangor and Negeri Sembilan by stratified proportionate random sampling based on the multi-ethnic population and the urban-rural location of schools. Subsequently, the schools were assigned randomly to intervention and control groups. The intervention schools underwent MyBFF@school program, whereas the control followed standard school curriculum for a duration of six months. The intervention modules replaced the existing two physical education classes and one co-curriculum activity per week. Three assessments i.e. at baseline, month-3 and month-6 were conducted. Anthropometric, clinical examination, blood, physical fitness, nutrition, and psychology parameters were collected.

RESULTS: Twenty-three out of 1,196 primary schools (seven interventions and 16 controls) and 15 out of 416 secondary schools (six interventions and nine controls). The investigators screened 11,950 primary (age 9-11 years) and 10,866 secondary (age 13, 14, 16 years) schoolchildren. The investigators found 3,516 primary schoolchildren (29.4%) and 2,910 secondary schoolchildren (26.8%) had BMI z-score of more than + 1SD who were eligible for the study. Of these, 39.7% (N = 1397) of the primary and 35.8% (N = 1041) of the secondary schoolchildren agreed to participate in the study. The mean (SD) characteristics for the participating primary and secondary schoolchildren were: BMI z-score, + 2.29 (± 0.81) and + 2.10 (± 0.71); waist circumference, 75.06 (± 9.6) cm and 85.5 (± 10.9) cm; percentage body fat, 37.8% (± 6.5%) and 39.2% (± 7.3%); and muscle mass, 14.7 (± 2.9) and 23.1 (± 5.2) kg respectively.

CONCLUSION: MyBFF@school program, a school-based multi-pronged intervention was designed to combat childhood obesity. Screening of 22,816 primary and secondary schoolchildren found 29.4% of primary schoolchildren and 26.8% of secondary schoolchildren to be overweight and obese which reflected the urgency for an effective intervention.

DESIGN: Scoping reviews support identification of a broad range of literature, including all types of study designs. We adopted Arksey and O'Malley's five-stage approach: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarising and reporting results.

DATA SOURCES: Databases searched included Academic Search Complete, Springer, Factiva, ProQuest, Ebsco, Informit, VOCEDplus and Scopus.

REVIEW METHOD: Based on our research question and inclusion and exclusion criteria we selected relevant literature and summarised and reported it using Arksey and O'Malley's framework.

RESULTS: The review yielded five articles from four countries: Sweden, Belgium, Malaysia and Australia.

METHODS: We invited eye care professionals to complete a two-round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub-region.

RESULTS: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub-regions, reducing out-of-pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas.

METHODS: This is a cluster randomized controlled trial which involved schoolchildren aged 13, 14 and 16 years old from 15 out of 415 government secondary schools in central Peninsular Malaysia which were randomly assigned into six intervention (N = 579 schoolchildren) and nine control (N = 462 schoolchildren). The intervention group was given NEI consisting of a nutrition education module carried out by trained personnel for 24 weeks on top of the existing curriculum while the control group only followed the existing school curriculum by the Ministry of Education. The primary outcomes were the nutrition knowledge and attitude score. The mixed effect model taking into consideration the cluster effect was used to assess the changes of nutrition knowledge and attitude scores from baseline until 6 months.

RESULTS: Overall, there was no significant increase in the adjusted mean difference (AMD) of nutrition knowledge score (AMD = 0.33%, Confident Interval (95 CI): -4.35% to 5.01) between the intervention and control group after 6 months of intervention after controlling for nutrition knowledge score at baseline, gender, location and ethnicity. Similarly, after controlling for the nutrition attitude score at baseline, ethnicity, location and gender as well as taking into account the cluster effects, there was no significant increase on the AMD of nutrition attitude score in the overall (AMD = 0.194, (95 CI): -1.17 to 1.56) and also among girls, location (urban vs rural) and Malays. There was also no significant reduction of AMD in the nutrition attitude score among boys and non-Malays.

CONCLUSION: MyBFF@school with NEI resulted with no significant improvement for nutrition knowledge and attitude among older schoolchildren. Therefore, to effectively impart the nutrition knowledge and change their nutrition attitude requires an in-depth study and multi-pronged and customized approach.

DESIGN: Systematic review and meta-ethnography.

DATA SOURCES: Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015).

ELIGIBILITY CRITERIA: Primary qualitative studies focused on adult community-dwelling stroke survivors' and/or informal caregivers' experiences of primary care and/or community healthcare services.

DATA SYNTHESIS: A set of common second order constructs (original authors' interpretations of participants' experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods' criteria.

RESULTS: 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke.

LIMITATIONS: Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems.

CONCLUSIONS: Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services.